12 Things Medicare Covers That Many Pennsylvanians Don’t Know to Ask For

Medicare covers a lot more than most beneficiaries realize.

But the program does a famously poor job of letting Pennsylvanians know what’s actually available.

Here are the things Medicare covers that many Americans are clueless about.

Obesity Behavioral Therapy

For Medicare beneficiaries with a BMI of 30 or higher, Medicare covers up to 22 face-to-face counseling sessions per year focused on weight loss through diet and exercise.

The sessions have to happen in a primary care setting, like a doctor’s office, not at a specialist or commercial weight-loss program.

The first six months include weekly visits, dropping to biweekly, then monthly if the beneficiary loses at least 6.6 pounds in the first six months.

Most primary care offices don’t promote this benefit, so it’s worth asking directly.

If your doctor accepts the assignment, there’s no copay.

Marriage and Family Therapy

Starting January 1, 2024, Medicare began covering services from Marriage and Family Therapists and Mental Health Counselors for the first time.

This added roughly 400,000 mental health providers to Medicare’s network, representing about 40% of the country’s licensed mental health workforce.

Previously, Medicare only paid psychiatrists, psychologists, clinical social workers, and psychiatric nurses.

For beneficiaries who’ve been told the local therapist doesn’t take Medicare, it’s worth asking again.

Many providers who weren’t eligible before now are.

Acupuncture for Chronic Low Back Pain

Since 2020, Medicare has covered acupuncture for chronic low back pain only.

The benefit covers up to 12 sessions in 90 days, with an additional 8 sessions if the beneficiary shows improvement.

The yearly maximum is 20 visits.

The pain must have lasted 12 weeks or longer and not be related to surgery, pregnancy, or a known cause like cancer or infection.

The catch is the provider rules.

Medicare doesn’t pay licensed acupuncturists directly.

The acupuncture has to be performed by a doctor, nurse practitioner, or physician assistant with credentials in acupuncture or Oriental Medicine.

The Diabetes Prevention Program

Medicare covers a free 2-year Diabetes Prevention Program for beneficiaries with prediabetes, available once per lifetime.

The program runs 16 weekly group sessions over six months, followed by monthly maintenance sessions.

The CDC reports it cuts the risk of developing type 2 diabetes by 71% in adults 60 and older.

Eligibility requires a BMI of 25 or higher (23 if Asian) and recent blood test results showing prediabetes.

Most beneficiaries with prediabetes are never told about this program. A doctor’s referral isn’t required, but bloodwork within the past 12 months is.

The Annual Wellness Visit

Medicare Part B covers a yearly Wellness Visit at no cost to the beneficiary, as long as the doctor accepts assignment.

The catch is what it isn’t.

The Annual Wellness Visit isn’t a physical exam. It’s a planning appointment where your doctor reviews medical history, runs a health risk assessment, and creates a prevention plan.

Many beneficiaries assume it includes a physical, and then get billed when the doctor performs additional exams beyond the wellness review.

To stay free, the appointment should focus on prevention planning only.

Anything diagnostic, like investigating a new pain or symptom, gets billed separately.

Smoking Cessation Counseling

Medicare covers up to 8 face-to-face smoking cessation counseling sessions per year, free, even for people who don’t have a smoking-related illness.

That’s a big change from the old rules, which only covered counseling after a smoking-caused diagnosis like emphysema or lung cancer.

Now any smoker on Medicare can get help quitting at no cost, including counseling with a qualified clinician.

The sessions can be split into two cessation attempts of four sessions each.

Medicare Part D may also cover prescription smoking cessation medications.

Continuous Glucose Monitors

Medicare expanded coverage for continuous glucose monitors (CGMs) in 2023 to include anyone on insulin for diabetes, regardless of insulin type, dose, or frequency.

This change made roughly 1.5 million more Americans eligible.

The 2025 expansion added beneficiaries on basal insulin and those with a history of problematic low blood sugar events, even without intensive insulin therapy.

A CGM attaches to the body and tracks blood sugar in real time, with alerts when levels are too high or low.

The device is far more useful than finger-stick testing for managing diabetes day to day.

Therapeutic Shoes for Diabetics

Medicare covers one pair of therapeutic shoes per calendar year, plus inserts, for beneficiaries with diabetes-related foot conditions.

Coverage includes one pair of extra-depth shoes with three pairs of inserts, OR one pair of custom-molded shoes with two pairs of inserts.

The doctor managing the diabetes has to certify the need, and a podiatrist or qualified specialist has to prescribe and fit the shoes.

Medicare pays 80% after the Part B deductible.

For diabetics with neuropathy or a history of foot ulcers, this benefit can prevent serious complications down the road.

Lung Cancer Screening

Medicare covers a yearly low-dose CT scan to screen for lung cancer for beneficiaries who meet age and smoking history requirements.

Eligibility requires being between 50 and 77, having a smoking history of at least 20 pack-years (a pack a day for 20 years, or two packs a day for 10 years), and either currently smoking or having quit within the last 15 years.

The beneficiary must also be asymptomatic, meaning no current symptoms of lung cancer.

The screening is free with no copay or deductible.

Eligibility was expanded in 2022 from the previous starting age of 55 and a 30-pack-year requirement.

Cardiac Rehabilitation

Medicare covers comprehensive cardiac rehabilitation programs for beneficiaries who’ve had a heart attack, bypass surgery, stent placement, heart valve repair, or a few other qualifying conditions.

Coverage includes up to 36 sessions of monitored exercise and education over a 36-week period, with possible extension to 72 sessions if medically necessary.

The program reduces the risk of a second cardiac event and helps with recovery.

Many cardiac patients leave the hospital without ever being referred to rehab.

A direct conversation with the cardiologist can fix that, and the benefit makes a meaningful difference in long-term outcomes.

Bone Mass Measurement

Medicare covers a bone density scan (DEXA) every 24 months for beneficiaries at risk for osteoporosis, and more often if medically necessary.

Eligibility includes women whose doctor determines they’re estrogen-deficient and at risk for osteoporosis, people taking steroids long-term, those with hyperparathyroidism, and anyone being monitored on osteoporosis drug therapy.

There’s no copay if the doctor accepts the assignment.

This is the standard test for catching bone loss before a fracture happens.

Many women on Medicare have never had one because their doctor never brought it up.

Medical Nutrition Therapy

Medicare covers Medical Nutrition Therapy for beneficiaries with diabetes, kidney disease, or who’ve had a kidney transplant in the past 36 months.

The benefit includes an initial nutrition assessment, individual or group counseling, and ongoing follow-up to help manage the condition through diet.

A registered dietitian or qualified nutrition professional provides the service, and a doctor’s referral is required.